| NPI | 1598050064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: FL ME166267) |
| Additional Taxonomies | 208600000X Surgery (Licence: CO DR.0060237) |
| 208600000X Surgery (Licence: SC 91477) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2024-06-19 |